Abstract P206: Importance of Timing of Initiation of Therapeutic Hypothermia in Patients With Sudden Cardiac Arrest
Background: Improving survival and brain function after initial resuscitation using hypothermia protocol from SCA remains a critical challenge for the clinicians. We evaluated the various factors affecting the survival after SCA after initiation of hypothermia protocol in our institution.
Methods: 58 consecutive patients who had SCA (due to ventricular fibrillation (VF) and asystole), with restoration of spontaneous circulation after successful resuscitation, were screened for inclusion in this study. Out of this, 31 patients who had VF, underwent therapeutic hypothermia as per the International Liaison committee on Resuscitation protocol were evaluated. Hypothermia was achieved using cooling blankets and a bladder temperature probe was used to monitor the core body temperature. The core body temperature was maintained at 32 to 34°c for a period of 24 hours. Active rewarming was started after 24 hours at a rate of not more than 1° in 4 hours.
Results: Thirty one patients with a mean age of 73±13.8 years underwent therapeutic hypothermia protocol. The mean left ventricular ejection fraction was 35.8±15.8 and 63% were men. Hypothermia protocol was initiated either in the emergency department or in the intensive care unit. Survival rate at discharge was 38.7 %. 11 patients developed acute renal failure out of which 6 patients survived and one patient needed hemodialysis.
Conclusions: Timing of initiation of the resuscitation and hypothermia plays a significant role in the outcome of the survivors of SCA. Collapse to ROSC and ROSC to cooling time are important determinants for survival. System wide education and implementation of a central paging system to activate all the staff involved (EMS, emergency room physicians, and intensivists) to shorten the time of initiation of hypothermia might improve survival.